Provider Demographics
NPI:1336350875
Name:HAMILTON, JUDITH L (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:26056 CATON LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OR
Mailing Address - Zip Code:97456-9452
Mailing Address - Country:US
Mailing Address - Phone:541-847-1149
Mailing Address - Fax:541-847-1149
Practice Address - Street 1:344 A ST
Practice Address - Street 2:SPRINGFIELD MUNICIPAL JAIL
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4536
Practice Address - Country:US
Practice Address - Phone:541-744-4166
Practice Address - Fax:541-744-4188
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350125 FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR040159Medicaid
OR079043995RNOtherSTATE LICENSE
OR200350125-FNP-PPOtherSTATE LICENSE
OR200350125-FNP-PPOtherSTATE LICENSE